DE3115960C2 - Ligature device - Google Patents

Abstract

It is a surgical ligature device for applying and pressing essentially U-shaped clamps on a blood vessel or the like. described to tie this off. The device has two handles that can be moved towards one another like pliers, the front ends of which terminate in clamping jaws. In the first handle there is an elongated recess which forms a magazine for receiving a row of clips which lie flat against one another. The two jaws of the handles have stops for the foremost clamp in the row in order to align them correctly for use. A spring-loaded shoe is housed in the magazine located in the first handle in order to constantly apply and advance the row of clips and to press the foremost clip against the stops. The two handles can be moved between an open normal position and a closed pressed position. With the help of a spring, the handles and their jaw sections are biased into the open normal position.

Description

The invention relates to a surgical ligature device for positioning and pressing U-shaped Clamps around vessels o their front end in jaws o. The like. Leak / wipe an open normal and a crimping The closed position can be moved and biased into the normal position and that with a magazine is equipped for a staple supply, from which hcraus the clamps one after the other against a stop defining the compression position in the area of the Clamping jaws can be advanced.

Ligature devices are used for tying or clamping of blood vessels or other tubular bodies. They are known in a wide variety of designs.

U.S. Patents 3,687,138,4038,988 and 4,050,455 describe Ligation devices with which a knotted loop made of catgut or synthetic suture material is wrapped around a tubular body. With these devices, the manual tying is also included Mechanized using conventional sutures.

Ligature devices that clamp off the tubular body with the aid of U-shaped clamps are for example

20 in U.S. Patents 3,777,533, 3,867S44 and 4,027,510. According to this prior art, a clamp is placed individually between the clamping jaws of the ligature device inserted and then pressed. Because of the lack of a magazine supply working with these devices is comparatively slow.

Still other ligature devices are used in conjunction with a separate magazine from which each a bracket in the middle !; of the ligature device pulled out and then crimped around the tubular body. Such devices are in US-PS 36 31 707, 37 74 438 and 38 27 277. It is necessary to pull out one clip at a time from the separate magazine additional working time, which is very valuable during an operation

Finally, the prior art also knows such ligatures that have an integrated magazine. In the case of US Pat. No. 2,874,384, this magazine extends in a transverse direction to the ligature device. The magazine / in according to US-PS 35 81 551 takes the brackets in a vertical stack and a number of other publications describes ligature devices with magazines, in which the brackets are rearranged in such a way that the legs of a brace butt against the crown of the previous staple, reducing the number of staples to be accommodated in the magazine Brackets remains comparatively small. Such a Ligaiurgerät is for example in US-PS 29 68 041 or US Pat. No. 3,082,426. Disadvantageous in

so RiHc of these two devices is that the clamp advance can be done manually independently and in addition to the manual movement of the clamping jaws must and both devices - like the rest of the prior art - have a comparative complicated structure, although the ligature device according to US-PS 30 82 42b already two pliers-like to each other has pivotable handles with Klemmbakkeri at their front ends and thus a Step zyr represents simplification,

μ The DE-AS 27 04 224 remains to be mentioned in the a magazine for a staple sewing device is described, in which the sewing replacing staples under the bias of a spring are arranged within the magazine, so that the foremost bracket is automatically pressed into the processing position due to the spring preload.

In terms of staff shortages and costs, the Increasingly, hospitals are striving to

to replace the devices with single-use devices in order to reduce the cost of sterilization. This endeavor requires on the manufacturer's side a range of inexpensive ligature devices, also due to their Construction be suitable for mass production have to. At the same time, such an inexpensive one must also be The ligature device should be as easy to use as possible, in order to reduce working hours, especially for larger operations not to take unnecessary claims.

The invention was based on the object of such To create ligature device that is not only inexpensive to manufacture in large numbers, but also about it can also be handled easily.

Starting from a ligature device of the type mentioned at the beginning and the US-PS 30 82 426 corresponding GaI-device this object is achieved in that in the a handle an elongated recess starting at the clamping jaw is provided, which holds the magazine forms, in which all brackets in parallclen to each other Planes are arranged adjacent to each other so that the entire stock of staples is consistently below a bias is that presses the foremost clamp against the stop, and that of each Jaw protrudes in the plane of the stop in each case a surface in the direction of the other jaw and both surfaces together form the stop.

Preferred configurations and developments of this solution are listed in the subclaims

A comparison between the proposed solution and the prior art clearly shows that the inventive Ligature device has a very simple structure, accommodating a large supply of staples allows and by the surgeon no attention or activity for the clip advance requires. It goes without saying that this ligature device is made of both a sterilizable material, such as. B. Metal can be made. Because of its great simplicity, however, it is more special than once suitable device.

A preferred embodiment of the invention is shown below with reference to the drawings explained in more detail. It shows

F i g. I a plan view of the ligature device; F i g. 2 shows a side view of the device according to FIG. 1;

p i g. 3 is a cross section taken along line 3-3 of FIG Fig. 1:

4 shows a perspective view of a preferred one Shape of the shoe arranged in the ligature device;

5 is a plan view similar to FIG. 1 of the Ligation device with handles and clamping jaws in the open normal position:

F i g. 6 is a partial view from below of the jaw area of the ligature device in the open normal position;

F i g. Figure 7 is a partial section along line 7-7 of Figure 5;

Fig. 8 is a partial section along line 8-8 of Fig. 5;

F i g. 9 is a partial view from below of the clamping jaw area of the ligature device similar to FIG. 6, but with the clamping jaws in the closed position;

Fig. 30 is a front view of a for the ligature in specific bracket;

F i g. 11 is a side view of the clip according to FIG Fig. 10, looking at the right side from Fi g. 10;

FIG. 12 is a cross section taken along line 12-12 of FIG

Fig. 10;

13 shows a cross section similar to FIG. 12 for Representation of a different knurl pattern on the inner surface of the bracket;

14 shows a perspective view of a blood vessel attached clip according to FIG. 10;

F j g. 15 Sine of Fi g. 14 similar perspective view a clamp in an intermediate stage of pressing; and

ίο F i g. 16 a FIG. 14 and 15 are similar perspective views the clamp in its crimped end position.

At the beginning the F i g. 1 and 2 explained in which the same parts are provided with the same reference numerals, is The ligature device is designated as a whole with 1 Es has a first handle 2 and a second handle 3, which are rotatably connected to one another around a pin 4 are. The first handle 2 runs on its front in a jaw 5. A corresponding jaw 6 is located at the front end of the ^ "wide handle 3.

The ligature device 1 can be made of stainless steel or make a different material that can be used for surgical purposes and could thereby provide a permanent, be a reusable and sterilizable surgical instrument. Because of its simple structure however, the device can alternatively be made from plastic, for example from polycarbonate reinforced with glass or nylon etc. It is then a single use disposable one Surgical device The last-mentioned embodiment is preferred, so that the ligature device 1 below is described as a device made of plastic.

The first handle 2 has according to FIGS. 1 to 3 a substantially rectangular cross section and can have an arcuate handle element 7 at its rear end. About its length away is an elongated recess in the first handle 2 8 molded. This recess 8 represents a magazine for receiving a row 9 of staples This row 9 is only indicated schematically in Figure 3, and only the bracket 10a at the very front and the rearmost bracket are distinguished here 10ödcrSeries9.

If the bracket is on a tubular part, for example that is, is placed on a blood vessel or the like, the clamp is at 90 ° to this tubular part aligned. The ligature device 1 is when setting a

so clamp held at about 45 ° to the tubular part. Accordingly, the staples within the row 9 in the magazine 8 are aligned inclined to the rear and are at an angle of approximately 45 ° to the bottom surface 8a of the magazine G, as shown in FIG. 3 can be seen.

The cross-sectional configuration of the magazine 8 depends on the shape of the brackets within the row 9 and should be chosen so that the brackets of the row 9 are well received. It should be noted that the row S of staples can be pushed forward through the magazine in a simple manner, while the individual staples within the row retain their intended orientation.

Since the recess forming the magazine 8 extends over the entire length of the first handle 2, the staples can be inserted into the magazine from the rear end of the handle 2. That The rear end of the handle 2 can then be fitted with a correspondingly designed lock

close. As an example of such a closure a stopper II is shown, which is inserted into a slot 12 is inserted. This slot extends partially through the handle 2 in the transverse direction.

Immediately behind the row 9 of clips is a shoe 13. This is shown in FIGS. 3 and 4 good to recognize. It is an elongated component that is essentially the same shape as the one inside the Magezins 8 located brackets may have. This correspondence in shape is from a comparison the F i g. 4 and 10 can be seen, FIG. 10 an example for a bracket to be explained below. The in F i g. The shoe 13 shown in FIG. 4 has two facing downwards extending side walls 13 a, 136 by a inverted V-shaped top wall 13c are interconnected. The shoe 13 is at its rear end by a rear end wall 13t / closed (see F i g. 3), while it is open at the front. The front facing Boundary edges of the shoe are inclined towards the top at an angle of about 45 °, about the inclination of the rearmost bracket in row 9 10ύ to match.

Immediately behind the shoe 13 in the magazine 8 there is a compression spring 14, which is shown schematically in FIG away. Spring 14 and shoe 13 cooperate to constantly act on the row 9 of clips and to bring the foremost clip 10a of the row into a position for subsequent use. Accordingly, the advance of the clamps within the row 9 is necessarily automatic and completely independent of the force that is required to operate the ligature device 1.

According to Figure 3, the upper surface of the first handle 2 ends at its front end in an upwardly and rearwardly inclined edge 14; the angle of inclination is around 45 °. The bottom surface of the first handle 2 ends in an edge 16 which is also inclined ^{back and down at an angle of about 45 C.}

F i g. S shows a plan view of the ligature device 1 and F i g. 7 shows a section along the line 7-7 of FIG. 5. It can be seen from these drawings, that the top of the first handle 2 (in Fi g. 5) in a downward and forward inclined forehead 15 merges, which at about 45 ° to the (in Fig. 7 above lying) bottom surface 8a of the magazine 8 runs. The bottom surface 8a is set along the lower side wall (Fig.5) in the form of a rail 18 on which one leg can slide along each bracket. This is in FIG. 7 clearly visible.

The top of the first handle 2 runs according to FIG. 5 also, in a front edge 19 from - is inclined forwardly and downwardly and terminates at the bottom surface 8a of the magazine 8 - again at an angle of approximately 45 °. This is in FIG. 8 shown. The bottom surface 8a of the magazine 8 again extends close to this front edge in the form of a rail 20 along which the other leg of the clamps slides

The front edge 19 of the top of the first handle 2 (FIG. 5) runs further forward than the front one Edge 17 of the underside and has the shape of a hook, as shown in FIG. 6 can be seen. This creates a front surface 21, which slightly overlaps the front end of the magazine 8: and one used for positioning The stop for the foremost bracket 10a of the row 9 is formed. This stop or the surface 21 runs again at an angle of 45 ° to Bodenfläc 8a of the magazine 8. The edge 15 of the upper part of the first handle 2 is at a distance from the surface 21, which is slightly greater than the thickness of a bracket is, as also applies to the rail 20. This creates a surface 22 (FIG. 6) between surface 21 and the edge 15 and the front end of the rail 20, which is a clamping surface and is used to close a clamp and which serves to the front end of the top of the first handle 2 (Figure 5) to the already mentioned jaw 5 make (see also Fig. 6).

is With reference to Figs. 1, 2, 3 and 6 should now the second handle 3 will be described. This second handle 3 has at its rear end in turn, an arcuate grip element 23, which is similar to element 7 as the one shown

; k> Embodiment is a device made of plastic, is in the straight rear part of the handle 3 has an axial bore 24 for the purpose of saving material intended. At the front end of the part of the second handle 3 having the axial bore 24 there is dicscr forked In the F i g. 3 and 6 are the corresponding Gabcl sections 25 and 26 can be seen, between which the first handle 2 extends and on which the first handle 2 is articulated by means of the pin 4. The Gabclabüchnitte 25,26 are made by a Scitcn-

3i> wall 27 connected, which at its front end in is essentially hook-shaped and has a region 27a which runs approximately at right angles thereto and is at an angle of about 45 ° upwards and backwards. The inner corner of the free end of the A barrel section 27a is grooved and forms a first upward and rear sloping surface 25, that of the surface 21 of the first handle 2 corresponds and in the same way as a stop for the foremost bracket in each case 1 Oa of row 9 is used. The groove also forms a

Second surface 29, which extends upwards at an angle of approximately 45 ° and represents a clamping surface corresponding to surface 22, which is designed to interact with flange 22. to close the foremost clamp 10a around a tubular part. Accordingly, the front end of the second handle 3 forms the already mentioned clamping jaw 6. The section 27a of the side wall 27 of the second handle 3 has an inner surface 27A (see FIGS. 6 and 9). which upwards and backwards at an angle ν η

5i) is inclined at about 45 ° and the front edge 17 of the right side of the first handle 2 (Fig. 6) straight can happen.

The two handles 2, 3 connected by the pin 4 can be switched between an open and a closed

5S these positions can be rotated relative to each other. The open position of the ligature device 1 is shown in FIGS. 5 and 6, in which the clamping jaws 5, 6 are accordingly also open. The closed position of the two handles used for pre-pressing is initially determined by the contact between the two jaws 5, 6 at 31 (Fig. 9). This position is also determined by a stop 32 which is formed on the second handle 3 and is against one side of the first handle 2 sets. This reduces the forces acting on the pin 4

Finally, to complete the device a spring assembly is provided that handles the two handles 2, 3 biases in their open position. In your illustrated embodiment, the ligature device 1 is equipped with a leaf spring 33, which is integrally from second handle 3 protrudes. The free end of this spring 33 rests on the first handle 2 and presses the two handles - and thus also the two jaws 5, 6 - in the in F i g. 5 open position shown. It is obvious that a person skilled in the art would also use a metallic one Leaf spring or another Fcdcrclemcnl can provide the integral plastic Replaced spring 33.

In Figs. 10 to 12, the preferred one is exemplified Shown in the form of a ligature clip 34. This bracket 34 is made of a material that meets the conditions of Ch'-urgie corresponds and permanent in the human Body can remain. For example, tantalum is a material that is particularly suitable for these purposes.

The bracket 34 is generally in the shape of a kinked one U with parallel legs 35 and 36 and a crown 37 connecting them. Although the crown too can be designed arcuately, is shown Continuation of an inverted V according to FIG. 10 preferred.

According to FIG. 11 edges 38.39 on. and when a number of such clips are arranged in a row, there is an edge 39 of each clip at the edge 38 of the next bracket, as can be seen in FIGS. 3, 7 and 8. The position of the KL / nmern with abutting edges 38,39 within a row of brackets is the relative position of the brackets to one another, which is elsewhere is also described as "lying flat against one another"

To assist in gripping the tubular part to be tied, it is preferred that the inner surfaces the legs 35.36 and the crown 37 are provided with knurling. Such a knurling 40 with diagonal mutually extending lines on the inner surface of the leg 35 and the adjacent area of the crown 37 is shown in FIG. Preferably also the The rest of the inner surface of the crown 37 and the leg 36 are provided with the knurling. Alternatively, the inner Areas of the legs 35 and 36 as well as the crown 37 can also be provided with double knurling 41, as shown in FIG. 13 is shown

In FIGS. 4 to 16, the use of a clamp 34 for tying off a tubular part 4Z, that is to say a blood vessel, is shown. The ligature device 1, not shown, is brought up to the vessel 42 at an angle of about 45 °, so that the vessel 42 comes to rest between the clamping jaws 5 and 6 As shown in FIG. 14, when the clamping jaws of the ligature device 1 are pressed together, the uppermost area of the crown is initially bent so that the free ends of the legs 35, 36 of the clamp are brought together. By further pressing the jaws 5, 6 together by moving the handles into their closed position, the legs and the crown sections are pressed against one another, so that the vessel 42 located therebetween as shown in FIG. 16 is tied. To ensure that the crown portion of the staple during piecing from the bracket at first bend (as in Fig. 15), the g as part of the inventive teaching in Fi. 10, the notch 43 shown in dashed lines can be provided on the inside of the crown where the bend is to take place

After the description of the structural details of the ligature device 1 and the bracket 34 should now whose mode of operation is described. The surgeon touches the device so that his thumb

S lies on the grip element 7 and his middle finger lies, for example, on the grip element 23. The ligature device is initially the in F i g. 5 have the open position shown. By the interaction of the shoe 13 and the Compression spring 14 ensures that the foremost

ίο Clamp 10a of row 9 in attachment to stop 21 of the Jaw 5 and the stop 28 of the jaw 6 is located. The ligature device is then placed under the vessel to be ligated approximated to an angle of about 45 ° so that the vessel passes between the clamping jaws 5, 6. After that the surgeon presses the two handles 2, 3 together against the force of the leaf spring 33. the The clamping surface 22 of the jaw 5 and the clamping surface 29 of the jaw S now act on the Seine of the foremost Bracket. By squeezing it further, the surgeon causes the jaw 6 to go over the magazine

8 and the foremost bracket in the row

9 in connection with FIGS. 14 to 16 described way sets and press !. The handles are then released to return to their open position and the ligature device is removed from the ligated vessel, thereby also releasing the compressed clip from the device. Immediately following this, the shoe 13 and the compression spring 14 cause the next following clamp to become the foremost clamp of the row 9 and lie against the stop 21 of the jaw 5. If the jaw 6 is not yet in the vol! are in the open position, the clamp initially simply lies against the inner surface 27b of the jaw 6. When the latter reaches the fully open position, the clamp rests on the stop surface 28. whereupon the next binding can take place.

For this purpose 4 sheets of drawings

Claims (7)

3ί 15,960 patent claims: 1. Surgical ligature device for positioning and pressing U-shaped brackets around vessels o. The like, which has two tong-like handles that can be pivoted relative to one another, on their Front end run out in clamping jaws or similar, between an open normal and a crimping serving closed position are movable and biased into the normal position and that with a magazine is equipped for a staple supply from which the staples one after the other can be advanced against a stop defining the compression position in the area of the clamping jaws are, characterized in that in the a handle (2) an elongated recess beginning at its jaw (5) is provided, which forms the magazine (8), in which all the clips (10) adjoin one another in planes parallel to one another are arranged that the entire supply of staples is constantly under a pretension, which presses the foremost staple (IQa) against the stop, and
that from each clamping jaw (5,6) in the plane of the stop one surface (21, 28) projects in the direction of the other clamping jaw and both surfaces together form the stop. 2. ligature device according to claim 1, characterized in that that ti / e brackets (10; 34) within the Row (9) inclined backwards in the magazine at an angle of about 45 ° to the longitudinal axis of the magazine (8) are arranged 3. ligature device according to claim ι or 2, characterized characterized in that the clamping jaws (5,6) rails (18,20) o. The like. Have which continuations of the magazine (8) bi! -den. 4. ligature device according to one of claims 1 to 3, characterized in that the handles (2, 3) including their clamping jaws (S, 6) are made of plastic exist. 5. ligature device according to one of claims 1 to 4, characterized in that within the magazine (8) behind the last bracket (10 / ^ of the row (9) a slidable shoe (13) and behind the shoe a preload which acts on it generating compression spring (14) is arranged. 6. ligature device according to at least one of the preceding claims, characterized in that that the row (9) of brackets (10; 34) in front and on their sides of the jaws (5,6) and in the longitudinal direction is held between the surfaces (21, 28) and the shoe (13). 7th Ligaiur apparatus according to one of Claims 1 to 6, characterized in that one end of a leaf spring (33) is fastened to one of the handles (2, 3), the other end of which rests against the respective other handle under prestress.